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MDMA and Sexual Behavior

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MDMA and Sexual Behavior Note: This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Substance Use & Misuse following peer review. The definitive publisher-authenticated version [McElrath K (2005) MDMA and sexual behavior: ecstasy users’ perceptions about sexuality and sexual risk, Substance Use & Misuse, 40:9, 1461-1477] is available online at http://www.informaworld.com/smpp/title~db=all~content=g714012467 MDMA and Sexual Behavior: Ecstasy Users’ Perceptions About Sexuality and Sexual Risk KAREN MCELRATH School of Sociology and Social Policy, Belfast, Ireland Published in Substance Use & Misuse,(2005) 40:9,1461—1477 This study examines the relationship between MDMA (Ecstasy), sexual behavior, and sexual risk taking. The sample consisted of 98 current and former users of MDMA. Several strategies were utilized to recruit respondents and data were collected through in-depth interviews during 1997 and 1998. The majority of respondents had used MDMA during the 6-month period prior to the interview and a large percentage had consumed the drug on 100 occasions or more. Most respondents reported feelings of emotional closeness while consuming MDMA but without the desire for penetrative sex. Others, however, reported that MDMA increased sexual arousal and some respondents (in particular gay and bisexual females) had used MDMA specifically for sexual enhancement. Sexual risk taking (e.g., having multiple partners, engaging in sex without a condom) was prevalent among respondents who did engage in sexual activity during MDMA episodes. Explanations for the findings are offered and implications for prevention/intervention are discussed. Keywords MDMA; ecstasy; sexual behavior Introduction Although a patent for 3,4-methylenedioxymethamphetamine (MDMA) was issued in 1914 (Shulgin, 1986), “recreational”a use of the drug did not surface until the 1970s and 1980s, and for the most part was restricted to selected regions in the U.S. (Beck and Rosenbaum, 1994). The drug’s street name “Ecstasy” probably was coined in the early 1980s (Beck and Rosenbaum, 1994), allegedly chosen as a marketing tactic (Eisner, 1994). The degree to which the street name, Ecstasy, accurately describes the effects of MDMA has been discussed in the literature. For example, some researchers have noted that MDMA increases sexual arousal in users (Halley, Valdez, and Kaplan, n.d.; Smith, Larive, and Romanelli, 2002; Winstock, 1993) and similar claims have appeared in drug use prevention outreach material (e.g., Bad Boy Club Montreal, n.d.). Other research has suggested that MDMA users are more likely than non-MDMA users to report diminishing sexual interest (Parrott et al., 2001). However, MDMA users in that sample had used the drug frequently and also reported use of other drugs; thus, it is unclear whether the alleged effects of MDMA on sexuality are affected by consumption patterns of MMDA, other drugs, or drug interaction effects. Some research has found that MDMA appears to increase the desire for sexual activity, although sexual performance is impaired for several users (Zemishlany, Aizenberg, and Weizman, 2001). Other accounts have supported the claim that some if not most users experience impaired sexual performance while consuming MDMA (e.g., Beck and Rosenbaum, 1994; Buffum and Moser, 1986; O’Dwyer, 1992; Saunders, 1997; Solowij, Hall, and Lee, 1992). Most of this research suggests that feelings of sensuality, openness, and collective empathy take precedence over sexual pursuits, however, Eisner (1994, p. 44) alludes to the importance of set and setting by suggesting that sexual activity during MDMA consumption is possible “when it feels appropriate to express love sexually . ” Buffum and Moser (1986, p. 359) found that although MDMA did not increase the desire to initiate sexual activity, the drug worked to “enhance receptivity to being sexual.” a The author acknowledges the subjectivity of the phrase “recreational drug use” Please use the following citation: McElrath K (2005) MDMA and sexual behavior: ecstasy users’ perceptions about sexuality and sexual risk. (Author postprint) in Substance Use & Misuse, 40:9, 1461-1477, [Accessed: (date) from www.drugsandalcohol.ie] 1 Few studies have examined the relationship between MDMA and sexual risk taking.b Halley, Valdez, and Kaplan (n.d.) conducted qualitative interviews with 25 MDMA users in Texas and those authors observed that most respondents had engaged in unprotected sex during MDMA episodes. Strote, Lee, and Wechsler (2002) studied drug taking (largely alcohol) and other behaviors of university students in the United States. The data were collected by mail survey and the response rate differed substantially across universities. The authors found that respondents who reported using MDMA in the past 12 months were more likely to have had multiple sex partners in the past month, compared to respondents who had not used MDMA. Those authors also found that MDMA users had higher rates of cigarette smoking and marijuana use in the past 12 months, and higher rates of binge drinking compared to respondents who had not used MDMA. Because the study was based on a cross-sectional design, causal linkages could not be ascertained. For example, Boyd, McCabe, and d’Arcy (2003) examined Ecstasy use among undergraduate students in one U.S. university. Using multivariate analysis, the authors observed that the number of sex partners significantly increased the probability of using Ecstasy. Cross-sectional data generally do not permit an assessment of whether sexual behaviors occurred during episodes of MDMA use or whether the behaviors were part of a broader lifestyle pattern that was characterized by risk taking in general. Reports from some countries have suggested that use of MDMA as well as other drugs are factors that contribute to sexual risk taking among men who have sex with men (MSM) (Halkitis and Parsons, 2002; National Institute on Drug Abuse, 2000). Use of MDMA has been linked with unprotected sexual activity in MSM from Boston and New York City, although polydrug use was quite common among respondents (Case, 2001). Findings from some studies of MSM have suggested that use of MDMAis linked with having multiple sex partners (Klitzman et al., 2002) and unprotected anal sex (Klitzman et al., 2002; Klitzman, Pope, and Hudson, 2000; Waldo et al., 2000). Risky sexual behavior has been linked with the use of MDMA and other drugs among gay males who attend “circuit” parties (Mattison et al., 2001). Although several MDMA users have fairly extensive drug histories, unprotected anal sex among MSM has been found to be associated with use of MDMA, controlling for use of other drugs (Klitzman, Pope, and Hudson, 2000). Still though, users of other drugs also have been found to engage in various forms of sexual risk taking. For example, a school-based self-report study of 9997 adolescents (mean = 16 years) from the Atlantic region of Canada (Poulin and Graham, 2001) found that the frequency of alcohol and cannabis use increased the likelihood of unplanned sexual intercourse. However, controlling for other variables, alcohol use (measured in terms of frequency, intoxication, binging) failed to emerge as a significant predictor for multiple sex partners or for inconsistent condom use. A study of 100 “sexually active women” by Taylor, Fulop, and Green (1999, p. 1213) found a statistical association between the number of times intoxicated and the number of sex partners. However, cigarette smoking also was linked with the number of sexual partners; thus, the authors suggested the possibility that these patterns might have been part of a “wider cluster” of social behaviors. They did not suggest that the linkages were causal. Moreover, women in that sample reported that alcohol consumption rather than drugs increased the probability of—but did not cause—sexual activity. Peugh and Belenko (2001) reviewed the literature on substance use, sexual arousal, and sexual function. The authors observed that most experimental and quasi-experimental studies have focused on alcohol and have relied on samples of young male adults. Still though, the authors concluded that some drugs appear to have a positive effect (perceived or otherwise) on sexual arousal, whereas other drugs reduce the likelihood of sexual arousal and impact negatively on sexual function. b “Sexual risk taking” is also a subjective phrase. Behaviors defined as “risky” by researchers may not be perceived as such by drug users. Please use the following citation: McElrath K (2005) MDMA and sexual behavior: ecstasy users’ perceptions about sexuality and sexual risk. (Author postprint) in Substance Use & Misuse, 40:9, 1461-1477, [Accessed: (date) from www.drugsandalcohol.ie] 2 The purpose of the present qualitative study is two-fold. First, I describe Ecstasy users’ perceptionsc about the drug’s effects with respect to sensuality, sexuality, and sexual performance. Second, I examine sexual risk taking during episodes of MDMA use. Methods The primary data for this study were collected through face-to-face, semi-structured interviews with current and former Ecstasy users in Northern Ireland. The criterion used for interview eligibility was any use of Ecstasy. We used this very general criterion and monitored the sample closely throughout the study, knowing that we could narrow the study criteria at a later date.d A total of 106 respondents were interviewed, however, eight interviews were discarded because of recording or transcribing problems, leaving a sample size of 98
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